目标温度管理 33 度与 36 度的比较：一项回顾性队列研究。

Targeted Temperature Management at 33 Versus 36 Degrees: A Retrospective Cohort Study.

机构信息

Department of Emergency Medicine, University of Washington, Seattle, WA.

Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA.

出版信息

Crit Care Med. 2020 Mar;48(3):362-369. doi: 10.1097/CCM.0000000000004159.

DOI:10.1097/CCM.0000000000004159

PMID:31809279

Abstract

OBJECTIVES

To determine the association between targeted temperature management goal temperature of 33°C versus 36°C and neurologic outcome after out-of-hospital cardiac arrest.

DESIGN

This was a retrospective, before-and-after, cohort study.

SETTING

Urban, academic, level 1 trauma center from 2010 to 2017.

PATIENTS

Adults with nontraumatic out-of-hospital cardiac arrest who received targeted temperature management.

INTERVENTIONS

Our primary exposure was targeted temperature management goal temperature, which was changed from 33°C to 36°C in April of 2014 at the study hospital. Primary outcome was neurologically intact survival to discharge. Secondary outcomes included hospital mortality and care processes.

MEASUREMENTS AND MAIN RESULTS

Of 782 out-of-hospital cardiac arrest patients transported to the study hospital, 453 (58%) received targeted temperature management. Of these, 258 (57%) were treated during the 33°C period (targeted temperature management 33°C) and 195 (43%) were treated during the 36°C period (targeted temperature management 36°C). Patients treated during targeted temperature management 33°C were older (57 vs 52 yr; p < 0.05) and had more arrests of cardiac etiology (45% vs 35%; p < 0.05), but otherwise had similar baseline characteristics, including initial cardiac rhythm. A total of 40% of patients treated during targeted temperature management 33°C survived with favorable neurologic outcome, compared with 30% in the targeted temperature management 36°C group (p < 0.05). After adjustment for demographic and cardiac arrest characteristics, targeted temperature management 33°C was associated with increased odds of neurologically intact survival to discharge (odds ratio, 1.79; 95% CI, 1.09-2.94). Targeted temperature management 33°C was not associated with significantly improved hospital mortality. Targeted temperature management was implemented faster (1.9 vs 3.5 hr from 911 call; p < 0.001) and more frequently in the emergency department during the targeted temperature management 33°C period (87% vs 55%; p < 0.001).

CONCLUSIONS

Comatose, adult out-of-hospital cardiac arrest patients treated during the targeted temperature management 33°C period had higher odds of neurologically intact survival to hospital discharge compared with those treated during the targeted temperature management 36°C period. There was no significant difference in hospital mortality.

摘要

目的

确定目标温度管理目标温度为 33°C 与 36°C 与院外心脏骤停后神经功能结局的关系。

设计

这是一项回顾性、前后对照队列研究。

地点

2010 年至 2017 年期间，城市学术一级创伤中心。

患者

接受目标温度管理的非创伤性院外心脏骤停成人。

干预措施

我们的主要暴露是目标温度管理目标温度，该温度于 2014 年 4 月在研究医院从 33°C 改为 36°C。主要结局是神经功能完整出院存活率。次要结局包括住院死亡率和护理过程。

测量和主要结果

782 例院外心脏骤停患者被送往研究医院，其中 453 例（58%）接受了目标温度管理。其中，258 例（57%）在 33°C 期间接受治疗（目标温度管理 33°C），195 例（43%）在 36°C 期间接受治疗（目标温度管理 36°C）。接受 33°C 目标温度管理治疗的患者年龄更大（57 岁比 52 岁；p<0.05），心源性心脏骤停比例更高（45%比 35%；p<0.05），但其他基线特征相似，包括初始心脏节律。接受 33°C 目标温度管理治疗的患者中，40%存活且神经功能良好，而 36°C 组为 30%（p<0.05）。在调整人口统计学和心脏骤停特征后，33°C 目标温度管理与出院时神经功能完整存活的几率增加相关（优势比，1.79；95%置信区间，1.09-2.94）。33°C 目标温度管理与显著降低住院死亡率无关。在 33°C 目标温度管理期间，目标温度管理的实施速度更快（从 911 呼叫到开始 1.9 小时，而不是 3.5 小时；p<0.001），在急诊科期间更频繁（87%比 55%；p<0.001）。